Menlo Park, Stanford medical facilities penalized over patient safety

Stanford Health Care and Palo Alto Medical Foundation's Menlo Park Surgical Hospital will see their Medicare reimbursements drop by 1 percent after Medicare found their patients had too many hospital-acquired conditions, according to documents recently released by the federal Hospital-Acquired Condition (HAC) Reduction Program.

The program was created in 2010 as part of the Affordable Care Act to improve hospital quality. The fines are based on assessments of complications from hospital stays, including infections, sepsis and hip fractures. This year, Medicare is penalizing 758 hospitals nationwide. It is the first time that Stanford and the Menlo Park facilities have been on the list, according to the documents.

Medicare ranked the nation's hospitals on a score of 1 to 10, with 10 being the worst in three categories: central-line associated bloodstream infections; catheter-associated urinary-tract infections and serious complications, which include eight types of injuries, including blood clots, bed sores and falls.

Hospitals with total HAC scores above 7 will be penalized, according to Kaiser Health News, which analyzed the documents.

Kaiser Health News is produced by the Menlo Park-based Kaiser Family Foundation, which is not affiliated with the Kaiser Permanente healthcare and insurance system.

The government assessed incidents in 2013 and 2014 for patients who developed infections after having central lines inserted into veins and/or urinary catheters. Most of these complications were part of last year's penalty assessments; incidents of infections from incisions from colon operations and hysterectomies were added to the calculations this year, Kaiser noted.

The remaining assessments were based on eight other complications, including surgical tears, collapsed lung, broken hips and reopened wounds that occurred between July 2012 and June 2014. Most of the complications were also part of last year's penalty assessments, but colon and hysterectomy operation infections were added to this year's assessments.

One in six hospitals is being penalized, but Congress exempted from the assessment veterans' and children's hospitals and critical-access hospitals, which are generally the sole providers in their area, the Kaiser report noted.

The penalties are in effect from October 2015 through September 2016 and will cost hospitals an estimated $364 million, according to Medicare, the Kaiser report noted.

Of local hospitals, Stanford, Menlo Park and Kaiser Permanente Redwood City scored above the penalty threshold of 7 for total hospital-acquired conditions. El Camino Hospital in Mountain View had the best scores.

Rajneesh Behal, Stanford Health Care chief quality officer, said in a statement that the hospital fully supports public reporting and sharing these quality and safety indicators.

"In the timeframe covered for this program (2012-2014), Stanford's rates for some of the included conditions were higher. All of these conditions are included in our quality improvement plan, and we have already significantly reduces the rates  some by 50 percent  for each of the conditions. It should be noted, the HAC program lags and does not reflect our current performance," he said.

A request for comment from the Palo Alto Medical Foundation regarding the Menlo Park Surgical Hospital was not yet returned.

Monique Binkley Smith, a spokesperson for the Palo Alto Medical Foundation, said: "At Menlo Park Surgical Hospital, patient safety is our highest priority. We are proud of the exemplary surgical care we provide to our patients, and we work every day to improve and enhance patient experience and safety. One isolated incident occurred in 2013, which was immediately rectified and the patient made a full recovery. Our goal is to provide every patient with the best possible care, every time."

Here is some anecdotal confirmation of basis for Medicare's decision: I had Mandible Ameloblastoma tumor excision end of this past June (with titanium plate replacement). Recovery revealed acquisition of a Strep infection at the site of the Transflap surgery. That's what they mean by "hospital acquired condition."

I was given massive doses of antibiotics to fight the Strep. That killed not only the bad germs, but all the good ones as well. And that, in turn, induced Clostridium difficile colitis, popularly known as C-Dif. This is a disease that is highly prevalent in some hospitals, apparently including Stanford. During this protracted ordeal, I was returned to the ICU at one point and my condition became critical several times.

In short, a brief hospital surgical post-op stay ended up with several additional hospital stays and a recovery that is still on-going. Medicare was billed for all this; Stanford accounting specified an over $800K tab. Thanks, Stanford Hospital.

I was a patient for a few days at Stanford Hospital earlier this year. The nursing staff, doctors, and assistants were all very careful and considerate. I did have a fall which was my own fault--I had a walker and failed to use it. I am unhappy that the hospital gets blamed for that. Infections on the other hand are very serious and do arise from carelessness somewhere along the line.

I've never understood how taking away money helps any institution improve since sometimes it is the lack of money that causes problems, for example, under staffing.

I always wondered why if the hospital or doctor causes an infection or surgical injury does the patient and the patient's insurance (or Medicare) get billed for the medical required to heal the patient. The facility and doctor should have to absorb that expense. Their screw-up they should have to pay the piper.

Posted by Westside Trucker
a resident of Atherton: West Atherton
on Dec 17, 2015 at 11:01 am

I was at Stanford last year for a week in the Emergency ward, a 3 bed room. The screens between the beds were filthy,and were opened and closed several times an hour by everybody from a janitor to a nurse. I caught a hospital blood infection while there. I had a blood draw every couple of hours day and night by indifferent, methodical and rough people.The IV in my arm came out twice while the anti-biotics were installed.

I had a permanent PICC line installed in me that supplied medicine into my vein by a great nurse who taped sterile paper to the screens to make a sterile cocoon. During the difficult and dangerous procedure, the screens burst open and someone came in and started to explain my financial responsibility.

Stanford should spend more money on cleaning up, and less on art museums for wealthy alumni

Posted by Jbcham
a resident of Atherton: West Atherton
on Dec 17, 2015 at 12:13 pm

I had two hospitalizations for two hip replacement surgeries, one in Nov 2009 and the other in Feb 2014. In both cases my treatment was outstanding. The surgeon was the "Best of the best." The staff of nurses and Rehab people were tremendously attentive and responsive and the student doctors (Stanford is a teaching hospital) were very competent and friendly. I could not be more satisfied with my treatment.

Posted by hope for the future
a resident of another community
on Dec 17, 2015 at 2:20 pm

I have every reason to believe that the interim CEO and President, Marianne Byerwalter, will do a terrific job getting Stanford Hospitals and Clinics back on track. These last years have been bumpy, but with the right change of management comes hope. She's wonderfully qualified and, while I understand that she will just be the interim, it's a step in the right direction!